Dr. James Norman, the owner and operator of the Norman Parathyroid Center has agreed to pay $4 million to resolve allegations that he violated the False Claims Act (“FCA”) by knowingly engaging in various unlawful billing practices with respect to Medicare and other federal health care programs and their beneficiaries. The government alleged that Dr. Norman pocketed hundreds of thousands of dollars as a result of the fraud.
The settlement concludes a lawsuit originally filed by a former patient of Dr. Norman, Myra Gross, and her husband, Dr. David Gross, in the United States District Court for the Middle District of Florida.
Norman claims to have invented “minimally invasive” parathyroid surgery in the 1990s and claims he is the world’s most experienced parathyroid surgeon. His website states that he has performed more than 21,000 operations.
The lawsuit was filed under the qui tam, or whistleblower, provisions of the False Claims Act, which permit individuals to sue on behalf of the government for false claims and to share in any recovery. If an individual’s suit proves successful, the “whistleblower” is generally entitled to 15-30% of recovered funds. The United States Congress adopted the law in the late 1800s to expose fraud among contractors.
The False Claims Act allows the government to intervene and take over the action, as it did in this case. If the government declines to intervene, a whistleblower may choose to fight fraud on their own.
If the government declines to intervene in a whistleblower’s case, it is not a death-blow to the suit, as billions of dollars have been recovered “privately” in “declined cases.” In practice, private, “declined” whistleblowers serve as an efficient litigation tool for government recovery, as the government does not have to expend resources and time fighting fraud, but still receives large recoveries due to the work of whistleblowers and their attorneys.
In its complaint, the Gross’ provided information that allowed the government to allege that from April 2008 through December 2016, Dr. Norman submitted fraudulent claims to Medicare, TRICARE, and the Federal Employee Health Benefits Program for pre-operative examinations performed on the day before or the day of surgery.
He also allegedly charged and collected extra fees from federal health care beneficiaries for services for which he had already received payment from the government. These extra fees ranged from $150 to $750 for Florida residents, to $1,750 or more for patients who lived out-of-state. Collectively, Dr. Norman and his practice pocketed hundreds of thousands of dollars as a result of these illicit billing practices.
“Fraudulent billing of the government, while also charging Medicare and other federal health care beneficiaries extra fees for services that the government has already paid for victimizes taxpayers, military veterans, the elderly, and other members of our community, and will not be tolerated,” said Acting U.S. Attorney Muldrow.
In addition to paying $4 million, Norman has agreed to enter into a corporate integrity agreement (“CIA”) with the Inspector General of the U.S. Department of Health and Human Services.
The government’s action in this matter illustrates the government’s emphasis on combating health care fraud. Under the Obama Administration, health care fraud became a priority with the creation of the “HEAT” initiative within the Department of Justice. Billions of dollars in fraudulent health care costs have been recovered from providers, and the current administration has announced its commitment to use of the False Claims Act in the health care sector.
As a result of their information and cooperation with the government, Ms. Gross and her husband, Dr. Gross, will receive roughly $600,000 of the proceeds from the settlement with Norman.
Assessing a False Claims Act case in the health care arena can be difficult. The difference between fraud and acceptable practice is often tied to a complex blend of state and federal regulation. Consulting an experienced whistleblower attorney or an attorney who specializes in the False Claims Act may help guide a potential whistleblower’s claim.